J Anunayi

Abstract

Introduction: Gall bladder lesions include the varied spectrum of lesions encompassing inflammatory, benign, premalignant and malignant conditions. Progression from benign to malignant change is a complex process. The pathological importance of chronic inflammation leading to neoplasia has come into prominence in recent years. Multiple mechanisms are involved in the carcinogenesis and the most commonly disrupted gene is the p53 gene. Materials and Methods: In our prospective study, of three consecutive years duration a total of 262 specimens which included inflammatory, premalignant, and malignant lesions of the gall bladder were received. Immunohistochemical analysis with a p53 antibody was done on selected 60 specimens according to our inclusion criteria. Results: Of the received specimens majority (84.7%) were inflammatory lesions followed by precursor lesions (10.7%) and malignant lesions (4.5%). Chronic cholecystitis with cholelithiasis is the predominant lesion accounting for 33% of the cases. P53 expression was observed in 50% of malignancies and was not seen in any of the premalignant conditions. 11.8% of inflammatory lesions with thickened wall showed p53 expression. Conclusion: The most common histopathological diagnosis was chronic cholecystitis. Chronic inflammation is a major risk factor for malignancy. Careful pathological examination of gallbladder specimens should be done as the neoplastic process may present silently as cholecystitis. P53 expression in chronic inflammatory conditions indicates an important role of inflammation in chronic cholecystitiscarcinoma sequence. Early detection of p53 mutation by Immunohistochemical analysis, and regular follow up aid in optimal patient management. Keywords: Gall bladder, Cholecystitis, p53.

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Abstract

Introduction: In this era, as the life expectancy is increasing, women are experiencing a long postmenopausal phase. Postmenopausal bleeding (PMB) is a sinister complaint and accounts for about 10% of postmenopausal complaints. Being a symptom of varied etiologies and its strong association with malignancy, it should be diligently evaluated. Aims and Objectives: 1. To evaluate the histopathological spectrum of lesions presenting as PMB. 2. To estimate the incidence of premalignant, and malignant lesions presenting as PMB. 3. To confirm the benign nature of the lesions to prevent unnecessary radical treatment. Materials and Methods: This prospective study done from January 2016 to September 2017 and included the endometrial biopsies/curettages and cervical biopsies sent for histopathological examination from clinically diagnosed cases of postmenopausal bleeding. Results: Out of all the samples majority were benign lesions (44%), followed by premalignant (25.7%), malignant lesions (18.3%). Conclusion: A variety of histopathological findings are seen in PMB. Benign pathologies were more common in our study but the collective proportion of premalignant and malignant lesions is considerably higher in this study. Accurate diagnosis makes it much easier to counsel the patient about further course of management, prevent unnecessary radical treatment for benign conditions, prompt treatment, and vigilant follow up for malignant lesions. Keywords: Postmenopausal bleeding (PMB), Endometrial carcinoma, Histopathology.

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